Provider Demographics
NPI:1720377989
Name:PHILIPS, JENNIFER BROMLEY (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BROMLEY
Last Name:PHILIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ELIZABETH
Other - Last Name:BROMLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1025 MOREHEAD MEDICAL DR
Practice Address - Street 2:STE 500 FL 5
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2963
Practice Address - Country:US
Practice Address - Phone:704-355-3149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018-00087207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1720377989OtherOPTIMA HEALTH
VA1720377989OtherAETNA
VA1720377989OtherUSA MANAGED CARE
VA1720377989OtherANTHEM BC/BS
VA1720377989OtherVIRGINIA HEALTH NETWORK
VA1720377989OtherCORVEL
VA1720377989OtherTRICARE/CHAMPUS
NC1720377989Medicaid
VA1720377989OtherUNITED HEALTHCARE
VA1720377989OtherMULTIPLAN
VA1720377989Medicaid
VA1720377989OtherVIRGINIA PREMIER HEALTH PLAN
VA1720377989OtherCIGNA
VA1720377989OtherCOVENTRY HEALTH CARE